#2613 dietary fiber intake, their sources and mortality in adults on hemodialysis: the diet-hd study

Abstract Background and Aims Higher fiber intake is associated with lower cardiovascular and all-cause mortality in the general population, but their benefits and which sources of fiber are healthier in patients on hemodialysis are uncertain. Method Daily fiber intake (DFI) and their sources (vegetable and fruit, staple food and other sources) were ascertained by the Global Allergy and Asthma European Network food frequency questionnaire within the DIET-HD study, a multinational cohort study of adults on hemodialysis. Adjusted Cox regression analyses were conducted to evaluate the association of DFI and fiber sources (vegetable and fruit, staple foods, others[including dressing sauce etc.]) (both as tertiles and continuous) with all-cause and cardiovascular mortality. Estimates were calculated as hazard ratio (HR) with 95% confidence interval (CI). Results 8,110 patients were followed for median of 3.8 years (26,074 person-years). There were 2,953 deaths, of which 1160 cardiovascular-related. The median (interquartile range) DFI was 12.0 (8.1-17.5) gram per day and vegetables and fruits (49%) were the major source. Each unit increase in total DFI was not associated with either all-cause (hazard ratio [HR], 0.99; 95%CI:0.98-1.00, p = 0.37)or cardiovascular mortality (HR,0.99;95%CI:0.98-1.00, p = 0.08). Compared with patients in the lowest DFI tertiles (<9.5mg/day), the adjusted HRs for cardiovascular mortality among those in the middle (9.5-15.3 g/day) and highest tertiles (≥15.3 g/day) were respectively 0.97 [95% CI, 0.84-1. 13] and 0.79 (95%CI, 0.65-0.96) (P value per trend = 0.02). Each unit increase in fraction of DFI from vegetable and fruit was associated with lower all-cause (HR,0.70;95%CI: 0.57-0.86, p = 0.001) but not with cardiovascular mortality (HR,0.75;95%CI: 0.54-1.04, p = 0.08). Each unit increase in the fraction of DFI from other sources (including dressing sauce etc.) was associated with higher all-cause mortality (HR, 1.66; 95%CI, 1.22-2.27, p = 0.001) but not with cardiovascular mortality (HR, 1. 63; 95%CI, 0.83-2.24, p = 0.23). No association were observed between fiber from staple food and all-cause or cardiovascular mortality. Conclusion Fiber intake in the hemodialysis population is low. A higher fiber intake from vegetable and fruit, and a lower fiber intake from other sources (including dressing sauce etc.) is associated with lower all-cause death.